The inspection took place on 15 January 2019 and was unannounced. We previously inspected 21 Lime Street - Learning Disability and Autism ('21 Lime Street') in May 2016, at which time the service was rated outstanding. At this inspection we found the evidence continued to support the rating of outstanding and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

21 Lime Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

21 Lime Street accommodates a maximum of eight people with a range of mental health needs. The service is split across two floors. Nursing care is not provided. There were eight people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was also responsible for the management of the provider’s other small service nearby and was supported by a deputy manager.

People who used the service gave extremely positive feedback about how staff were patient and respectful with them. External professionals provided positive feedback and relatives gave exceptional praise to staff.

All staff interacted inclusively and engagingly with people. The culture of the service was completely focussed on people’s individualities and their contribution. The service worked flexibly and innovatively to ensure people who used the service felt at home and as in control as they wanted to be of how the home was run. This was consistent across all levels of staffing and had a demonstrably positive impact on people’s wellbeing and quality of life.

Activities provision remained exceptional, with people encouraged to pursue individual interests or partake in the many and varied group activities. The registered manager continued to use their love of music and multimedia projects to engage people in hobbies and projects they found fulfilling.

Links with the local community had strengthened and again had an extremely positive impact on people’s ability to make new connections and contributions, and to reduce the risk of social isolation.

The registered manager, their deputy, the operations manager and all staff interacted extremely well with people who used the service and staff. The culture remained extremely open, inclusive and the atmosphere was welcoming. This had been sustained over a number of years and ensured people were fully a part of the home they live in, and the community they were a part of.

People felt safe and were supported by knowledgeable staff who knew how to minimise the risks they faced. Risk assessments were in place and were specific to people’s individual needs and circumstances.

The care service was managed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Medicines management and administration practices were safe, with staff trained appropriately and their competence assessed. Staff demonstrated a good knowledge of people’s medicinal needs and liaised well with external professionals.

Staffing levels were appropriate to the needs of people who used the service and rot

The inspection took place on 4 May 2016 and was unannounced. 21 Lime Street- Learning Disability and Autism provides accommodation for up to eight people. There were seven people living at the home at the time of our inspection. People had their own rooms and the use of a number of communal areas including lounges, a dining room and kitchen, conservatory and garden areas.

We spent time with people who lived at the home and spoke with three people about their life at the home. The examples we have given are therefore brief because we respect people’s right to confidentiality.

A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were able to do things they enjoyed and keep in touch with those people who were important to them. Risks to people's safety were understood by staff and people benefited from receiving care which took into account their safety needs. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. People were supported to take their medicines so they would remain well and there were enough staff to meet people’s care and safety needs.

People were supported by staff who used their skills and knowledge so they would enjoy a good quality of life. Staff worked with other organisations and relatives so people's right to make decisions and their freedom was protected. Some people enjoyed making their own meals and drinks. Other people received help from staff to enjoy a range of food and drinks so they would remain well. People were supported to make their own health appointments where possible. Staff assisted people to attend specialist health appointments and followed the advice given by specialist health services so people would receive the care they needed as their health needs changed.

We saw caring relationships had been built with the staff and management team. People enjoyed spending time with the registered manager and people were given encouragement and reassurance when they needed it. People's need for independence and privacy was understood and acted upon by staff. People were encouraged by staff to make their own choices about what daily care they wanted.

People were supported to understand the values of the service and helped to develop the vision of how the home was run. People living at the home were empowered to decide what care they wanted and supported in innovative ways to do this. People’s preferences and goals were understood by staff and action was taken so people received the care they agreed to. Staff took action when people's needs changed. People and their relatives had not needed to raise any complaints about the service, but were confident action would be taken if complaints were raised.

There was open communication between people, provider, registered manager, relatives and staff. People were empowered to make suggestions about how the home was run and their suggestions were acted upon. Staff understood what was expected of them and were supported through regular discussions with their managers. This included support so staff cared for people in ways which promoted best practice. Regular checks were undertaken on the quality of the care by the provider and registered manager. Actions were taken in innovative ways to further develop people’s experience of care so the home would continuously develop.

We spoke with four people who lived there, three staff, the registered manager and a relative of one of the people who lived there. We also observed how staff cared for people.

We looked at care plans for four of the people who lived there. They covered a range of needs and had been reviewed regularly to ensure that staff had up to date information. There were also detailed assessments about the person's health so that staff could support people to keep healthy and well. All the staff we spoke with had knowledge of the needs of the people who lived there.

People who lived there were supported to make choices around the care they received. A staff member told us: “It’s not about what I (staff) want to do. It’s about what they (people who lived there) want to do”.

We saw that staff helped and supported people. We spoke with one relative of a person who lived there. They told us: “I know they (people who lived there) are all kept safe". We saw that people received care that met their individual needs.

People lived in a clean environment and the provider had reduced the risk of the spread of infection.

We found that staff received training and support to enable them to carry out their job roles effectively.

We found that there were regular audits and quality checks. We also saw that the provider sought on-going feedback from the people that lived there. This ensured that the provider was able to monitor the quality of its service delivery.

We spoke with four of the eight people who were using the service. We observed how staff interacted with people to support them in making decisions about their lifestyles. People responded in a positive way to staff suggestions. We spoke with a person who told us, "I love it here, it's super." Another person said, "I like it here. Staff look after me. I like going out to town, the market and car boot sales."

The three care files that we reviewed indicated that arrangements had been made to support people in receiving their care needs. The care files included information about people's preferences about activities and accessing the community and how they were met. We held discussions held with the registered manager, a senior care worker and a care worker. We found that people were well supported in leading a varied lifestyle that suited their individual preferences. Staff encouraged people in maintaining their independence.

People who lived at the home told us they felt safe. Staff had received training in safeguarding and knew how to respond to concerns.

We found that there were enough staff to meet peoples personal and health care needs as well as supporting them to lead a varied lifestyle to suit their individual preferences.

The people we spoke with told us they knew how to make a complaint but that they had not needed to. Staff told us how they would assist people in making a complaint.